Tonsillotome



Feb. 4, v1941. o. c. DANLELS TONSILLOTOME Filed Oct. 7, 1939 wucwtofqscar C Da niels 15 .ai 36 a7 r Patented Feb. 4, 1941 UNITED STATESPATENT ortica 2 Claims.

This invention relates to improvements in surgical instruments, itsparticular purpose being for severing and removing tonsils and the like.Reference is made to the patent to O. C. Daniels,

5 1,466,581 of August 28, 1923, on which the improvement Iis based. Itis thought unnecessary to describe the advantages of the knowninstrument at length because that was done in the foregoing patent. Itis desired vto state, however, .that in the use of the patentedinstrument it was found that the cutting blade is subject to a limitedjamming, thereby restricting the freedom of movement that is desired,also that the necessary looseness between the spindle and sleeve has thefault of rendering the instrument slightly unsteady at times. Thenecessity for said looseness comes out of a requirement for the easydisassemblage of the parts preparatory to sterilization, but this samelooseness has the fault of setting up some rattling when the parts arere-V assembled preparatory for use.

With this preamble in mind, the objects of the invention are as follow:Y

First, to provide a surgical instrument of the character stated whereinthe utmost freedom in the sliding movement of the blade is insured bythe provision of at least one stud or equivalent spacing means betweenthe frame and cover member, thereby to enable the operator to manipulatethe instrument smoothly and easily and without unduly jarring thepatient.

Second, to provide a brake between the spindle and sleeve so as tofrictionally hold the sleeve in reference to the spindle while makingpreliminary adjustments of the thumb wheel for the initial setting ofthe cutting blade.

Other objects and advantages will appear in the following specification,reference being had to the accompanying drawing, in which:

Figure 1 is a side elevation of a tonsillotome embodying theimprovements.

Figure 2 is a longitudinal section of a portion of the instrument,particularly illustrating the spacer stud and brake.

Figure 3 is a cross sectie-n taken on the line 3-3 of Fig. 2.

Figure 4 `is a cross section taken on the line 4--4 of Fig. 2.

Figure 5 is an inverted plan view of the cover member which carries thespacer stud.

Figure 6 `is a plan view of a portion of the blade.

Figure 7 is a plan View of the cover member, particularly illustratingthe 'brake spring on the spindle.

(crm-309) Figure 8 is a detail plan View of the cutting end of theinstrument.

Figure 9 is a cross section taken on the line 9-9 of Figure 8.

VFigure 10 is a longitudinal section taken on the line I-IU of Fig. 8.

For `the purpose of a general understanding of the patented instrument,the structure of the latter is described briefly before pointing outtheimprovements. A frame I provided with a handle 2 has a widened portion 3at one end. The upper face 4 of the frame is flat throughout its length.The widened portion 3 has an aperture 5 to receive the tissue to be cutoff. Said portion has a marginal fla-nge 6 which serves the purpose of aguide.

At a place adjacent to the handle '2 the frame I has an integralupstanding guide flange 8. This is substantially U-shaped in crosssec-tion (Fig. 3). A blade 9 is adapted to slide upon the at upper face4. This blade has a widened portion I (Figure 8) which is sharpened atits front end to provide a cutting edge II. The end of the bladeopposite to the widened portion is bent upwardly at I2, the resultingflange being recessed at I3 (Fig.`6).

A cover member I is seated upon the blade 9 to assist in its retention.Said member has a widened end portion I'S (Fig. 8) to match the widenedportion I0 of the blade. The edge I1 of the widened portion IS is smoothand is provided with lateral flanges I8. A boss I9 occurs on the covermember I5 at that end opposite to the widened portion IS. A spindle 2|projects from the boss I9. The spindle is integral with the boss and itsfree end is externally threaded as shown in Fig. 2. A sleeve 22 ismounted for rotation on the spindle 2| and is provided with a stud 23which is adapted to move in. a cam opening 24 in the ilange 8 so as todrive the widened portion I6 forwardly at a period in the operation ofthe instrument.

The sleeve 22 is externally screw threaded at 25. A nut 26 screwed ontothe threads of the spindle 2| provides a back stop for the sleeve 22,the boss I9 providing the companion front stop.

A thumb wheel 21 is screwed onto the threads 25 of the sleeve 22. It hasa grooved collar 28 with which the iiange I2 is loosely connected byvirtue of the recess I3 of the latter. A wing nut 29 is xedly secured tothe outer terminal of the sleeve 22 adjacent to the thread course 25.

An opening 30 in the frame I is undercut to receive the head 31 of aspring clip 35. The shank 36 of this spring clip is insertible throughslots 3| and 34 respectively in the blade 9 and cover member I5 prior tothe introduction of the head 31 into the opening 30. T'his is done withthe spring clip 35 at a position 90 degrees to one side of the ultimateposition in Fig. 1. 'Ihe turning of the spring clip to that positionlocks the shank 36 upon the frame I. The blade 9 and cover member I 5have an interenga-ging stud and slot connection not necessarily detailedherein, this ending the description of the known structure.

The impro-vement to the foregoing instrument involves several features,each of which is a contribution toward lthe better working of thedevice. A spacer stud 38 (Fig. 2) insures the utmost freedom of slidingmovement of the blade 9 because said stud is made suciently deeper thanthe blade 9 is thick to provide a noticeable clearance 38 above andbelow said blade. Actually the blade will ride the face 4, but it isconceivable that the blade may move up and down in the space providedfor it, this facility being the occasion for making particular referenceto the clearances 38. The stud 38 may be attached either to the frame Ior to the cover member I5. By preference it is a part of the covermember I5, but in either case it occupies a slot 39 in the blade, saidslot being specifically provided for the stud.

In order to make sure that the blade 9 will slide as freely at itswidened portion IU as elsewhere along its length, the manginal flange 6(Fig. 8) is provided with a separate groove 40 (Fig. 9) to which theside edges of the widened portion I6 of the cover member I5 are conned.The widened portion I0 of the blade 9 rides in individual grooves 4I towhich the side edges of said widened portion are confined. The blade 9is thus kept free from the cover member I5, and it is 4this spacing thatinsures the freedom of sliding movement of the cutting blade to whichmuch importance is herein attached.

In practice there have been instances when there was a tendency for theblade 9 toy retard a little during the operation. Such an occurrence isattended by a slight jarring of the patient due to an extra effort onthe part of the surgeon to manipulate the blade for the purpose ofovercoming the resistance. This fault is avoided by mounting the blade 9independently of the cover member I5 and in a sense also independentlyof the frame l. Instead of grouping the two widened portions I9, I6, inone slot, each is confined to its own slot in the marginal fiange 6,with the result already stated.

'I'he second feature which characterizes the improvement is the use of aspring 42 (Fig. 2) as a brake between the spindle 2| and Sleeve 22. Thisis preferably a leaf spring but not necessarily so. In the event .ofusing a leaf spring rivets 43 or their equivalents are employed torigidly set one end of the spring in a depression 44 in the stem 2|. Thespring 42 is fairly stiff, and inasmuch as its tension is outward itwill bear on the bore in the sleeve 22, producing a desired factor ofresistance.

Instead of utilizing the nut 26 as a means for clamping the sleeve 22and thus hold said sleeve against rotation of the spindle 2|, said nut26 is now used as a back sto-p between which and the boss I9 the sleeve22 is perpetually turnably mounted. In other words, the sleeve 22 isherein adapted always to be freely turnable between the front and backstops I9, 26, but in order to stabilize the sleeve use is made of thebrake spring 42 to steady the sleeve in respect to the spindle 2| whilemaking preliminary adjustments of the thumb wheel 21.

Such adjustments are made when setting the cutting blade 9 at thebeginning of an operation. At such a time it is most desirable to haveevery element to function properly and without hindrances. The surgeoncan give the wheel 21 one or two spins, thereby to slide the blade 9backward or forward and at that time it is desirable not to have thesleeve 22 turn.

This could be prevented by holding the wing nut 29 with the fingers ofthe other hand, but the use of the spring 42 does away with thatnecessity. The turning of the thumb wheel 21 can be accomplished withoutdisturbing the position of the sleeve 22 which might occur because ofthe frictional engagement of the threads, but the spring 42 holds thesleeve 22 with suflicient tightness in respect to the non-revolublespindle 2| that the spinning of the thumb Wheel 21 can be -accomplishedwithout having to hold the Wing nut 29.

Reverting to the free sliding of the blade 9 to the insurance of whichend the grooves 40, 4|, are provided (Fig. 9) due attention has beenpaid to the possibility .of some portion of membranous material catchingin the space between the blade 9 and the cover member I5. Said space,now designated 45 in Fig. 9, is slight, being only of a depth equal tothe thickness of the rib 46 which divides the grooves, but even thisslight space if left unguarded might cause the disorder just mentioned.

As a preventative the widened portion I6 is made eXtra thick at 41 (Fig.10). That is to say, the extremity of the portion |6 is made with anextra thickness underneath, substantially as suggested by the outline 41in Fig. 8. This extra thickness brings the material of the cover membervery close to the top of the blade 9. It thus functions as a closure forthe space 45 and also as a bearing member for the blade. If there shouldbe any tendency of the latter to deiiect upwardly the thickened portion41'would serve as a stop.

Briey stating the operation, the cover member I5 and blade 9 areretracted by pulling back on the wing nut 29. This can be done onlyafter the stud 23 has registered with the passage beneath the guidefiange 8. The widened portions IIl, I6, then clear the aperture 5. 'I'heinstrument is brought into position so that the tissue can be emplacedin said aperture. The nut 26 is then pushed upon by the thumb of thehand that holds the instrument until the tissue is pressedl between thesmooth edge I1 and the closed end of the marginal flange 6.

This portion of the operation is completed by turning the wing nut 29whereupon the stud 23 rides into the cam opening 24 and thus secures thewidened portion I6 in its clamping or squeezing position. 'Ihe thumbwheel 21 is now turned until the cutting edge appears beyond a slit inthe rounded end of the flange 6. This denotes the severance of thetissue and the severed parts are then removed.

I claim:

1. In a surgical instrument comprising a frame having two sets ofgrooves with an intervening rib, a cutting blade and a cover membersuperimposed on the blade, said blade and cover member beingindividually slidable in the respective sets of grooves, said ribspacing the cover member from the frame at the cutting end of the bladethus to insure the free sliding of the blade independently of the covermember; in combination, means for further spacing the cover member fromthe frame consisting of a spacer stud upstanding in reference to theframe and higher than the blade is thick, said blade having a Sletoccupied by the stud.

2. In a surgical instrument having a frame carrying a blade and a co-vermember for the lO blade, a spindle extending integrally from the covermember and having a depression in its cylindrical Wall, a sleeverevoluble on the spindle, said sleeve having a threaded portion, a thumbWheel having a `connection With the blade and being turnable on thethreads to reciprocate the blade, and -a leaf spring occupying thedepression, thereffore being interposed between the spindle and sleeveto brake the sleeve and check its tendency to turn when turning thethumb Wheel.

OSCAR C. DANIELS.

